RIGHT TO CHOOSE IS CHANGING

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To: NHS England, Integrated Care Boards (ICBs), and UK Government 
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We, the undersigned professionals, service users, families, and members of the public are deeply concerned by the potential changes under the proposed 2025/26 NHS Payment Scheme. As people working in or using services for neurodivergent people, the changes that the payment scheme proposes will significantly restrict the Right to Choose (RTC) for ADHD and Autism assessments, and post-diagnostic care. These changes will have significant consequences for thousands of individuals seeking diagnosis and treatment, exacerbating an already critical situation for neurodivergent people, and services who support them, in England.
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Background
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The RTC pathway has been vital for individuals facing extensive NHS waiting times for Autism and ADHD assessment and post-diagnostic care. Under this legal right, people could select alternative providers which allowed them to access assessment and support in a more timely manner. RTC does not remove the wait altogether, with many RTC providers having waiting lists of over 12 months. The NICE guidelines suggest individuals should be seen within 3 months of referral. Without a diagnosis, there is a significant impact on education, workplace and, relational functioning, as well as overall wellbeing.
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Services across the NHS are currently overwhelmed. In many regions, the waiting times exceed five years for an initial assessment or have waiting lists that are closed. For instance:
 

• Leeds and York Partnership NHS Foundation Trust: As of February 2025, the service has a waiting list of approximately 4,500 individuals, receiving around 170 referrals monthly. With resources to assess only about 16 people per month, new referrals could wait over ten years for an assessment. (LYPFT, 2025)

• Herefordshire and Worcestershire Health and Care Trust: Reported waiting times for adult ADHD assessments extend up to 550 weeks, over ten years (Price & Wilkinson, 2024).

• Devon NHS: As of February 2024, the current wait time was approximately 5 years and 6 months for an Autism Assessment (Devon Partnership NHS Trust, 2025).

Critical Impact
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Restricting this pathway now threatens to:

 

• Leave thousands in prolonged uncertainty. It is estimated that over 130,000 people are awaiting assessment at present (ADHD UK, 2023). Patients who relied on RTC will now confront indefinite delays, with no viable alternatives.

• Escalate mental health crises. Delayed diagnosis and treatment can lead to deteriorating mental health, employment challenges, academic difficulties, and an increased risk of self-harm (Mandy et al., 2022; French et al., 2023)

• Overburden an already strained NHS. Redirecting patients back to NHS waiting lists for assessments and treatment, as well as worsening mental health difficulties, will further overwhelm services, rather than alleviate pressure.

• Disproportionately affect vulnerable groups. Those from disadvantaged backgrounds, who already face healthcare access barriers, will be particularly impacted (Abdelnour, Jansen, & Gold, 2022; Aylward, Gal-Szabo, & Taraman, 2021; Mandy et al., 2022).

• Increase inequality. Individuals who have the financial means to fund their own assessments will access assessments and support privately.

• Further impact on education. Delayed access to diagnosis and support will leave more children struggling in education. This may lead to further exclusions and mental health difficulties, and lower academic achievement overall. Teachers will face more challenges in supporting children awaiting assessment and support, without proper resources in place (May et al., 2020; Russell et al., 2023).

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Call to Action
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We urgently call upon NHS England, Integrated Care Boards, and the UK Government to:

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• Reconsider the 2025/26 NHS Payment Scheme, specifically how this will impact assessments and care for neurodivergent people.

• Stop the proposed restrictions on the Right to Choose for ADHD assessments, ensuring all eligible patients maintain access to timely diagnosis and treatment.

• Increase investment in ADHD and Autism services, enabling NHS waiting times to become reasonable and reducing reliance on RTC over time.

• Engage with professionals, service users, and advocacy groups to develop a fair, accessible system that addresses the needs of those with neurodevelopmental conditions such as autism and ADHD.

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Yours Sincerely,
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Dr Lucy Rigley
Senior Clinical Psychologist
Leeds, West Yorkshire

www.drlucy.co.uk
info@drlucy.co.uk

 

PLEASE SIGN BELOW
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